Provider Demographics
NPI:1235006834
Name:CHANGES HEALING CENTER LLC
Entity type:Organization
Organization Name:CHANGES HEALING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHNATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-290-1681
Mailing Address - Street 1:7407 W ST CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7015
Mailing Address - Country:US
Mailing Address - Phone:602-691-7244
Mailing Address - Fax:
Practice Address - Street 1:7407 W ST CHARLES AVE
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-7015
Practice Address - Country:US
Practice Address - Phone:602-691-7244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHANGES HEALING CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty